By Eduardo Felipe Alfaro Valdés: persistent pain in victims of human rights during the period of 1973-1990

By Eduardo Felipe Alfaro Valdés: persistent pain in victims of human rights during the period of 1973-1990

For many years, chronic or persistent pain has been topic of discussion among the different disciplines that make up the area of health since it is currently a serious problem of public health around the world. Pain is one of the most frequent causes of consultation in the centers of health care in Chile, and may be present as a symptom in up to 70% of them. The prevalence of chronic pain varies from country to country. Globally, this is located in a range from 5% to 45%, while in Chile going from 8.6% to 31% according to the Chilean Association for the study of pain and palliative care (ACHED).

Well, the pain has been defined by different authors and scientific organizations. The International Association for the study of pain (IASP for its acronym in English) defines: "pain is an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage".

On the other hand, there are various structures in our body where pain is expressed in different ways (radiated, stabbing, burning, etc.). Pain is subjective, functions as a defense mechanism, prevents damage to ourselves, and alerts us damage to our body. In addition, it is worth mentioning that pain can be a much more complex experience, i.e., the word "pain" is also used to give a relationship to grief, loneliness and the feeling that no one understands the person. It is due to this, the need to reach a more global view to understand the pain.

In the last decade have emerged new studies about the persistent pain, advancing neuroscience and neuroimaging, has also generated a change in the understanding of this behavior in the brain. Some conclusions of these studies, mentioned that persistent pain is well the cortical reorganization or changes in brain connectivity while still more complex the task of power in fully understanding this disease. There is also an increase in investigations related to central sensitization (SC), whose "phenomenon" is understood as an increase in the excitability of neurons in the central nervous system that modifies the way in which is managed and processed the peripheral sensory information. The factors involved are not precise, however, has been shown the participation of different phenomena of neural plasticity induced by afferent activity of the peripheral nervous system, whose common element is the role played by the income of the signal nociceptive of great intensity from the periphery to the central nervous system (CNS), whose manifestations are spontaneous pain without the need for a painful stimulus, persistent pain, expansion of receptive fields in the neurons of the horns later (sensitive), hyperalgesia and allodynia.

Now, it is possible to deal with chronic pain or persistent musculoskeletal victims of torture during the 1973-1990 period in Chile from another point of view. There is an international law where the article 5 of the universal declaration of human rights, this says: "No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment and penalties." However, the paradox of this association between pain and article 5 of the universal declaration of human rights, is that, during the military regime in chile, the physical and psychological torture, pain, was the mechanism used by the armed forces, civil, even professional people in the area of health as doctors and nurses complicit in crimes of political repression by the State.

According to the information gathered by the truth and reconciliation commissions created by the Decree Supreme No. 355 of April 24, 1990, by President Patricio Aylwin, many methods of torture consisted of ligaments strains by hanging, vertebral fractures caused by direct hits or by use of electric current, fractures in bones of the Carpus, sexual violence, damage to the central nervous system by bullet impact, accommodations-fractures by hits, etc. Now, considering all the people who decided to declare, much of them have pathologies of the neuro-musculo-skeletal system according to the medical records of repair and comprehensive care (PRAIS) program.

However, in 28 years of recovered democracy, currently in Chile are unknown prevalence studies related to pain persistent Musculoskeletal and central sensitization in people undergoing extreme traumatization, however, if there is international scientific evidence which makes relationship between stress disorder post traumatic (PTSD), depression, multiple physical symptoms associated with chronic pain in victims of torture.Chronic pain is a disease prevalent in world population, impairs the quality of life, invalidate the person and causes serious transformations in interpersonal relationships. However, studies of the experience of physical and mental torture has been a fairly complex topic addressed by the health professionals that are related to the commitment of the State in the repair of the damage caused by dictatorship. We could say that we are faced with the production of a condition of chronic distress that has affected significantly the adaptive capabilities of these people to the demands of life, especially in areas such as affective ties, the socio-labour insertion, building family and parento-subsidiary tasks, socialization, etc.

28 years after the dictatorship, to students and professionals in the area of health, young living not the political repression of those times. We are facing a scenario where currently unknown dimensions and clinical sequelae that left the political repression of the State in many people. Because of this, needed further studies related to the context, to achieve a clinical understanding of the aftermath that left torture in Chilean who today suffer from mental and physical disorders whose rehabilitation is in charge the PRAIS.

By Eduardo Felipe Alfaro Valdés
Bachelor's degree in Kinesiology